Solitary intra-abdominal tuberculous lymphadenopathy mimicking duodenal GIST

Abstract

Tuberculosis remains prevalent in developing countries and has recently re-emerged in the Western world. Intra-abdominal tuberculosis can mimic a variety of other abdominal disorders, and here we describe a patient with solitary tuberculous mesenteric lymphadenopathy mimicking duodenal gastrointestinal stromal tumor (GIST). A 22-year-old woman complained of epigastric discomfort and was presumed to have a duodenal GIST after an endoscopic examination and abdominal CT scan. However, exploratory laparotomy revealed an enlarged node penetrating the duodenal bulb, which was diagnosed histopathologically as tuberculous lymphadenitis. This case suggests that in regions with a high prevalence of tuberculosis, intra-abdominal tuberculosis is often mistaken as a malignant neoplasm. A high index of suspicion and the accurate nonsurgical diagnosis of intra-abdominal tuberculosis continues to be a challenge.

Figure 1

An esophagogastroduodenoscopic (EGD) examination revealed a round mass with normal surrounding mucosa and central ulceration in the duodenal bulb.

Figure 2

Abdominal CT scan showing an exophytic well-defined round mass in the duodenal bulb. The mass enhanced as gastric mucosa and was presumed to be a duodenal gastrointestinal stromal tumor (GIST).

Figure 3

Endoscopic ultrasonography (EUS) showed an ulcerative hypoechogenic mass originating from the submucosal layer.

Figure 4

Histopathologic image of the enlarged perihepatic lymph node showed granuloma with caseation (H&E stain, ×200).